Introduction
During the pandemic, mental health service demand increases were reported worldwide (Saha et al., 2020; Benton et al., 2022; Deng et al., 2023; Sicouri et al., 2023), specifically in Aotearoa, New Zealand (NZ; Every-Palmer et al., 2020; Freeman et al., 2021; Gasteiger et al., 2021; Officer et al., 2022). Healthcare professionals (HCPs) faced the unusual challenge of sharing stressful situations with their patients, as navigating uncertain health risks, lockdowns, travel restrictions, and financial disruptions coincided with increased client distress and severity. In NZ, government-mandated restrictions were among the strictest and most effective in reducing the spread and mortality of COVID-19, such that widespread community transmission was not seen until the 2022 Omicron outbreak. At the time of this study in 2022, extended lockdowns had only recently ended, vaccination rates were high, and community transmission was increasing (Ministry of Health, 2022). Many psychologists continued to work remotely via telehealth.
The impact of the pandemic on HCPs has been reported by frontline medical workers, with rates of stress and anxiety particularly noted (Buselli et al., 2020; Bell et al., 2021). However, little research has been conducted on mental health professionals. During the pandemic, psychologists reported clients needing care as much or more than before, as the stress of the circumstances compounded existing challenges (British Psychological Society, 2020). Unprecedented numbers of people attended NZ hospitals for mental health emergencies, particularly among young people (Every-Palmer et al., 2020; Freeman et al., 2021; Gasteiger et al., 2021; Officer et al., 2022). However, the effects on psychologists went largely unexamined, with little consideration given to these professionals working to support their communities.
Pre-pandemic research established a significant risk of work-related stress, vicarious trauma, and burnout symptoms among psychologists. Estimates were that between 20 and 67% of psychologists experienced symptoms of burnout (Morse et al., 2012; McCormack et al., 2018; O’Connor et al., 2018; Simpson et al., 2019). In 2021, the second year of the COVID-19 pandemic, NZ psychologists reported significantly higher rates of burnout and secondary traumatic stress than caring professionals internationally and in earlier NZ-based studies (Kercher and Gossage, 2023). Psychologists also reported difficulties, mainly working with high-risk clients, stress, and depression symptoms, which were linked with compassion fatigue. However, the specific and prolonged effects of the pandemic were not clear, which was the motivation for the current study.
During the pandemic, psychologists and other mental health professionals saw the challenge of therapy moving online, a platform many had rarely used, and which brought ethical, legal, and technical difficulties (British Psychological Society, 2020). The benefits of ongoing connections and support for clients were numerous, with clients accessing services from home. Clinical practices have since changed, with services and training programs focusing more on online delivery than ever. Anecdotally, psychologists, like many others, reported challenges from juggling remote work with children schooling at home and other caring responsibilities, but this was not being measured formally. The current study sought to assess the challenges faced by psychologists during the pandemic and developed a questionnaire for this purpose (Rahman et al., 2024).
The current study focused on the effects of COVID-19 on psychologists in NZ. Psychologists undergo prescribed training and practice under comprehensive codes of conduct and ethics and are thus a relatively homogenous and standardized sample of mental health practitioners. By the third year of the pandemic, themes were beginning to emerge in anecdotal discussions among psychologists—telehealth fatigue, personal demands, client changes, and systemic challenges. This research investigated these factors and sought to understand the effects of COVID-related stressors on psychologists’ psychological symptoms and levels of compassion fatigue.
Discussion
Psychologists in Aotearoa, NZ, reported high rates of psychological distress, burnout, and secondary traumatic stress symptoms during the third year of the pandemic (2022). While a great deal of attention has rightly focused on frontline medical workers’ wellbeing and the risk of burnout during the pandemic, our study shows that psychologists have been experiencing the same difficulties.
Psychologists had higher average scores for depression, anxiety, and stress than pre-pandemic community norms (Crawford et al., 2011) and significantly higher average burnout and secondary traumatic stress than pre-pandemic psychologists in NZ (McCormick, 2014). Notably, NZ psychologists’ average distress was comparable with symptoms reported by frontline HCPs during the peak of the pandemic in Australia (Hammond et al., 2021), except for anxiety, which was higher for medical personnel—likely due to the intensity of emergency room work during this time which would drive autonomic nervous system arousal, as measured by the DASS-21 anxiety scale.
Psychologists in NZ reported higher average burnout and secondary traumatic stress than Italian frontline healthcare professionals during the peak of the pandemic, in intensely stressful and distressing conditions (Buselli et al., 2020). This may be because burnout is a slow-onset phenomenon, culminating in work-related issues over a long period (Stamm, 2002), whereas the Italian medical community was experiencing more acute and intensive stress. However, secondary traumatic stress can have a sudden onset, so, it is surprising that our rates were higher than the Italian HCPs on this scale.
Resilience was lower than pre-pandemic NZ psychologists (McCormick, 2014) and general community norms (Davidson, 2018). The latter is particularly surprising, as mental healthcare professionals typically show high rates of resilience (Davidson, 2018) and have a professional understanding of coping strategies. Interestingly, psychologists working with more at-risk clients reported higher resilience, though this was not significantly related to compassion fatigue or other measures of distress. It could be that psychologists self-select their work, and those with higher resilience elect to work with higher-risk presentations. On the other hand, compassion satisfaction scores were comparable with previous samples of NZ psychologists and frontline HCPs, suggesting that psychologists enjoy their work and find it rewarding. These results were comparable with our earlier sample of NZ psychologists in 2021 (Kercher and Gossage, 2023), so measurement errors are unlikely—psychologists have repeatedly reported elevated distress. Similar difficulties were reported for frontline HCPs (Bell et al., 2021) and psychiatrists in NZ during the pandemic (Chambers and Frampton, 2022), but with different measures preventing direct comparisons.
The current study sought to understand the role of COVID-19-related stress, among other workplace and personal factors, in contributing to the reported levels of compassion fatigue among NZ psychologists. We found that COVID-19-related stress was a predictor of CF, over and above psychological distress, years in practice, supervision, and non-significant predictors, including personal support, having children at home, and working with at-risk clients. Interestingly, receiving more supervision was associated with increased CF—perhaps those at risk of CF are actively seeking more support or working in settings where this is offered. However, working in public or private settings was not significantly associated with CF. Those with more years of practice experience reported higher CF in a model containing the other predictors. This is unusual—often, there is a “survivorship effect” seen in burnout, where those prone to experience it leave their roles early in their careers, and those with more years of experience appear more resilient to burnout (Rupert and Morgan, 2005).
Psychologists reported increases in stress and concern about work, caseload intensity, and personal responsibilities during the pandemic, with more than 90% reporting no increases in personal or professional support. While the pandemic has since eased, with the government of Aotearoa, NZ, removing the last of the public health orders (Government NZ, 2023), ongoing pressures continue for the mental health sector. Frequent reports emphasize shortages of psychologists (Psychology Workforce Task Group, 2016; Skirrow, 2021), psychiatrists (Thabrew et al., 2017), increases in demand (Every-Palmer et al., 2022), difficulties with access (Officer et al., 2022), and waitlists (Cardwell, 2021). Arguably, this is causing a worsening cycle of severity in the community—services triage patients and see the most severe cases first, leaving those with mild-to-moderate concerns without help. Without intervention, many psychological conditions worsen over time (Ghio et al., 2015) and are associated with an increased risk of suicide (Maslow et al., 2015). Clients receive treatment when their symptoms worsen (Blayney and Kercher, 2023). As a result, psychologists report increasing severity, intensity, and concern about their work, although this was not directly associated with CF in the current study.
Clearly, the mental health sector requires increased funding and resourcing ahead of future crises. The challenges of the pandemic exacerbated workforce shortages and increased demand on a sector already under strain and the psychologists working to support their communities. Given the increasing frequency of natural disasters and other challenges in Aotearoa, NZ, and worldwide, the mental health sector needs to be better prepared for such difficulties in the future. Learning from the impact of the pandemic on psychologists, we need to focus on better supporting our health and support services and improve the resilience of mental health systems in the future.
The cross-sectional nature of our survey was a limitation of this study. Due to anonymity, we could not compare responses with the survey conducted in 2021. Still, we can track average rates of distress and professional quality of life, which were comparable across the two samples. Although our sample size (N = 99) was modest, we recruited only registered, practicing psychologists who undergo extensive training and practice under standardized codes of conduct and practice in Aotearoa, New Zealand, thus providing a homogenous sample. However, self-selection bias is possible, whereby those under most stress or most at risk of CF may not take the time to answer a survey. The survey was also limited in socio-cultural diversity, with most respondents from European NZ backgrounds identifying as female participants. Invitations were extended to target Māori and Pasifika psychologists’ groups; however, response rates were low. It will be important for future research to engage better tangata whenua psychologists, who are at known risk of burnout (Levy, 2002; Hemopo, 2004).
Encouragingly, our respondents reported good average rates of compassion satisfaction. Additionally, more than 90% reported that they had no intention to leave the profession soon (in contrast with NZ psychiatrists, nearly half of whom reported intention to leave, Chambers et al., 2022). Psychologists report finding their work rewarding and satisfying, reflected in the reported sense of purpose and reward both here and internationally during the pandemic (British Psychological Society, 2020).
The strong implication of this study is that psychologists face significant challenges in their roles. Combined with workforce and health system data indicating continual increases in demand and insufficient resources, it is vital that the shortage of psychologists is addressed with increased training and that the mental healthcare sector in Aotearoa, NZ, receives increased resources. While supervision and workplace support were not protective against CF here, almost all respondents received the required minimum of monthly supervision sessions—arguably, without this, distress could be even worse. Relatively few psychologists received more supervision than this despite guidelines recommending additional sessions for less experienced practitioners, new areas of work, or client crises. Supervision and professional development are generally protective against burnout and distress for mental health professionals (Yang and Hayes, 2020), while supportive workplaces and manageable demands are also critical (Maslach and Leiter, 2016). A larger sample of psychologists would allow better investigation of these potential protective factors, wherein a focus on different types of resilience and the potential role of supervision is suggested. Workplaces, the healthcare sector, and psychologists’ organizations should consider screening psychologists for burnout and secondary traumatic stress and address both demands and support within their roles.